March 2016: Kigali, Rwanda

Emergency Medicine Residency Ultrasound Rotation
CHUK Hospital in Kigali, Rwanda

While many resources are limited, one thing that is now more consistently available in Rwanda – both at CHUK and in the district hospitals, is bedside ultrasound. Providing the knowledge and skill set to use this tool appropriately has significant value as there is not access to portable x-ray and CT capacity can be intermittent. PURE is enjoying coordinating the new emergency medicine residency’s ultrasound rotation and for the past few weeks I worked on this effort. Emergency medicine (EM) is a new specialty in Kigali based at the University Central Hospital of Kigali (CHUK) hospital in Rwanda, an academic referral and teaching center.

CHUK Hospital, Front Entrance. Kigali, Rwanda









The high volume of road traffic accidents makes the ultrasound training very important for the EM residents as it can aid in a much faster, and more affordable diagnosis of internal injuries (as there may also be payment issues with CT). During our scan shifts we diagnosed ocular injuries, fractures, pleural effusions, pneumothoraxes, cholecystitis, pericardial tamponade, small bowel obstructions, TB and cancer. Ultrasound in developing world often plays a huge role in cinching a more timely and accurate diagnosis.










In addition to using ultrasound in a diagnostic capacity, we also used ultrasound to guide procedures. We had one patient who came in with DKA, who was acidemic, hypokalemic and very ill appearing. She had waited overnight all night with no interventions, treatments or medication because the overnight team had been unable to gain peripheral access. In the morning, the residents were able to use bedside ultrasound to obtain a peripheral IV line and the patient ended up doing very well, and was discharged home 2 days later. We have also used the ultrasound to guide thoracentesis and pericardiocentesis procedures- primarily for patients with TB.

Bedside Ultrasound Teaching with Residents: CHUK









I found the use of ultrasound in Rwanda to be extremely rewarding, as we were able to change the course of treatment for multiple patients each day based on our ultrasound findings. In addition, the residents are eager to acquire the skill set, and are quick to learn ultrasound. While we are not necessarily going to get patients to come to the hospital earlier in their disease course, we can arm physicians with the ultrasound skills to more accurately diagnosis them when they arrive looking for help.

Kristin Dwyer, MD, MPH
Fellow in Emergency Ultrasound
Brigham and Women’s Hospital
Emergency Department
Emergency Ultrasound Division